Health and Medical News and Resources

General interest items edited by Janice Flahiff

Book Review: Avoiding self-sabotage

What makes your brain happy and why you should do the opposite

From the 28 December 2011 EurekAlert

Why do we routinely choose options that don’t meet our short-term needs and undermine our long-term goals? Why do we willingly expose ourselves to temptations that undercut our hard-fought progress to overcome addictions? Why are we prone to assigning meaning to statistically common coincidences? Why do we insist we’re right even when evidence contradicts us? In WHAT MAKES YOUR BRAIN HAPPY AND WHY YOU SHOULD DO THE OPPOSITE (Prometheus Books $19), science writer David DiSalvo reveals a remarkable paradox: what your brain wants is frequently not what your brain needs. In fact, much of what makes our brains “happy” leads to errors, biases, and distortions, which make getting out of our own way extremely difficult.

New Scientist says, “David DiSalvo takes us on a whistle-stop tour of our mind’s delusions. No aspect of daily life is left untouched: whether he is exploring job interviews, first dates or the perils of eBay, DiSalvo will change the way you think about thinking… an enjoyable manual to your psyche that may change your life.”

DiSalvo’s search includes forays into evolutionary and social psychology, cognitive science, neurology, and even marketing and economics—as well as interviews with many of the top thinkers in psychology and neuroscience today. From this research-based platform, the author draws out insights that we can use to identify our brains’ foibles and turn our awareness into edifying action. Joseph T. Hallinan, Pulitzer Prize-winning author of “Why We Make Mistakes”, calls DiSalvo’s book “the Swiss Army knife of psychology and neuroscience research—handy, practical, and very, very useful. It boils down the latest findings into simple easy-to-understand lessons you can apply to your daily life.”

Ultimately, DiSalvo argues, the research does not serve up ready-made answers, but provides us with actionable clues for overcoming the plight of our advanced brains and, consequently, living more fulfilled lives…

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June 4, 2012 Posted by | Psychology | , , , | Leave a comment

Hiding True Self at Work Can Result in Less Job Satisfaction, Greater Turnover

From the 31 May article at Science News Daily

Hiding your true social identity — race and ethnicity, gender, age, religion, sexual orientation or a disability — at work can result in decreased job satisfaction and increased turnover, according to a new study from Rice University, the University of Houston and George Mason University….

“When individuals embrace their social identity in the workplace, other co-workers might be more sensitive to their behavior and treatment of individuals like them,” said Juan Madera, a University of Houston professor, Rice alumnus and lead study author. “And quite often, what’s good for the worker is good for the workplace. The employees feel accepted and have better experiences with co-workers, which creates a positive working environment that may lead to decreased turnover and greater profits.”

The authors hope their research will encourage the general public to be accepting of people with diverse backgrounds and become allies to them and encourage employers to implement policies that foster a positive organizational culture.

“I think this study really demonstrates that everyone can have a role in making the workplace more inclusive,” Hebl said. “Individuals tell co-workers, who can act as allies and react positively, and organizations can institute protective and inclusive organizational policies. All of these measures will continue to change the landscape and diversity of our workforce.”…

June 4, 2012 Posted by | Workplace Health | , , , | Leave a comment

Researchers Learn About End-Of-Life Communication

From the 4 June 2011 article at Medical News Today

…Lead author Robert E. Gramling, M.D., Sc.D., associate professor of Family Medicine at URMC, and colleagues with a special interest in palliative care, made several key discoveries:

  • In 93 percent of the conversations, prognosis was brought up and discussed by at least one person, with the palliative care team broaching the issue 65 percent of the time. Also, the prognosis information focused more often on quality of life rather than survival, and on the unique individual rather than the population in general. Researchers noted that prior studies support the link between open and honest discussions about prognosis to clinical benefits.
  • Both patients/families and physicians/nurses on the palliative care team tended to frame prognosis with more pessimism than optimism. This was unexpected and different than the usual patterns of communication, where talk of a serious illness tends toward avoidance or unbalanced optimism, researchers said. However, emphasizing accuracy during the palliative care consultation usually leads to treatment decisions that match patient preferences.
  • The substance and tone of the conversations varied, depending on whether the patient was present and actively participating. For example, prognosis conversations with family members alone were more pessimistic and contained more explicit information. It is possible, researchers said, this type of conversation takes place out of respect for the patient, who might be sicker in this scenario, or is someone who prefers to avoid information.
  • The closer to death, the more likely the palliative care physician was to foretell or forecast events. This might seem logical – that doctors would guide patients and families in what to expect as death approached – but in reality this vulnerable and frightening time is when families often report a void in communication. The URMC data suggests that palliative care consultations respond to this need….

June 4, 2012 Posted by | health care, Psychology | , , , | Leave a comment

Evidence Based Medicine not the Holy Grail??

And don’t miss the lively discussion at the end of the article..

When self-evident truth in medicine is systematically ignored (KevinMD.com article of June 3, 2012)

Some things in medicine are obvious.  Despite the endless worship of ‘evidence-based’ medicine, and the constant barrage of studies on every conceivable topic, we do certain things because we know they just seem right.  I take as evidence the fact that we daily try to save lives, devoting research time, untold gazillions of  dollars and heroic clinical effort to our continued goal of staving off death.  Why is this?  Do we know that death is inherently worse than life?  Well, since we can’t see beyond the grave, and can’t exactly engage in double-blind, placebo controlled studies about the after-life, the answer is “no.” But we assume that life is preferable to death, based on our feelings, our sense of the thing.

 

The same is true in our personal lives.  No one can show me a scientific study that details why he or she married a particular person.  No one can offer up a mole of affection for empiric analysis.  And yet, we don’t doubt the existence of romance, or the reality of love.

And yet, medicine is filled with situations in which “self-evident truth” is systematically ignored, and those who believe in it intentionally and often viciously marginalized.

For example, after years of being told that physicians weren’t giving enough treatment for pain, and after years of clinicians saying, “yes we are, and too many people are addicted and abusing the system,” the data from CDC says that far too many are dying from prescription narcotics, far too many infants being born addicted, and far too many people, young and old, are using analgesics and other drugs not prescribed for them.  To which many of us say, “duh!”

And then there’s the customer service model, the thing which causes clinicians to lose their jobs as satisfaction scores fall due to disgruntled patients (often upset over not receiving the drug they desired … see above paragraph).  This is a darling of administrators.  And it clearly has flaws…

June 4, 2012 Posted by | health care | , , , | Leave a comment

NINIH-funded study examines use of mobile technology to improve diet and activity behavior

From the May National Institutes of Health (NIH) press release

A new study, supported in part by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, suggests that a combination of mobile technology and remote coaching holds promise in encouraging healthier eating and physical activity behavior in adults. The study focused on the best way to change multiple health behaviors.

The study results will appear Monday, May 28, in the Archives of Internal Medicine, with an accompanying commentary authored by William Riley, Ph.D., a clinical psychologist and program director for the NHLBI.

Scientists from the Northwestern University Feinberg School of Medicine, Chicago, along with colleagues from other institutions, studied 204 overweight and obese adults. Prior to enrollment, participants had a diet high in saturated fat and low in fruits and vegetables. They also engaged in little daily physical activity and had high amounts of sedentary leisure time.

Each participant was assigned to one of four groups:

  • Increase fruit and vegetable intake and increase time in moderate/vigorous physical activity
  • Increase fruit and vegetable intake and reduce time in sedentary leisure activities
  • Decrease fat intake and increase time in moderate/vigorous physical activity
  • Decrease fat intake and decrease time in sedentary leisure activities

All participants received mobile devices and were trained on entering information about their daily activities and eating patterns. Coaches studied the data received and then phoned or emailed participants to encourage and support healthy changes during the three-week study. Participants were also asked to continue to track and submit their data over a 20-week follow-up period. Financial incentives for reaching study goals during the study and continuing participation during the follow-up period were offered.

All four groups showed improvements in reaching the assigned health goals, with the most striking results occurring in the group asked to increase fruit and vegetable intake and reduce sedentary leisure activities. The researchers found after 20 weeks of follow up that this group’s average daily servings of fruits and vegetables increased from 1.2 to 2.9; their average minutes per day of sedentary leisure activity dropped from 219.2 to 125.7; and the percentage of saturated fat in their daily calories went from 12 to 9.9.

In his commentary, Riley noted that the use of mobile technology to improve cardiovascular health is worth further study of the effects on health outcomes and costs. Mobile technology offers the chance to deliver key health messages without waiting for intermittent visits with health care providers, he said.

June 4, 2012 Posted by | Consumer Health, health care | , , , | Leave a comment

For those interested in health system indicators (statistics)

142px;”>Health System Measurement Project

The Health System Measurement Project tracks government data on critical U.S. health system indicators. The website presents national trend data as well as detailed views broken out by population characteristics such as age, sex, income level, and insurance coverage status.

Not only can one view data, but one can customize graphs and tables

From the About Page

The Project focuses on ten critical dimensions of our health care system covering the availability, quality, and cost of care, the overall health of Americans, and the dynamism of the system. The Project examines the evolution of these aspects of our system over time. It also assesses the status of these dimensions of the system with respect to subgroups of the population, with a particular emphasis on vulnerable populations.

About the Topical Areas

The measures are divided into the following ten topical areas:

  • Access to Care
  • Cost and Affordability
  • Coverage
  • Health Information Technology
  • Innovation
  • Population Health
  • Prevention
  • Quality
  • Vulnerable Populations
  • Workforce

About the Functionality

With this web tool you can:

  • Quickly view data on a given topic from multiple sources
  • Compare national metrics with the same metrics measured at the regional and state level
  • See time trends for up to 10 years
  • Compare data across variables such as income, race, age, and insurance coverage type
  • View data in both graphical and table format

June 4, 2012 Posted by | health care, Health Statistics | , | Leave a comment

New AHRQ Report Finds Teamwork and Follow-Up as Strengths of Medical Offices but Work Pressure and Pace are Problemat

Agency for Healthcare Research Quality

From a recent email from AHRQ (US Agency for Healthcare Research and Quality)

Teamwork and patient care tracking/follow-up are strengths for medical offices, but work pressure and pace are areas for improvement, according to new results from the AHRQ Medical Office Survey on Patient Safety Culture. Most (84 percent) medical office staff feel they have good teamwork among staff and providers and that the office follows up with patients appropriately (82 percent). But only 46 percent of staff rated the work pressure and pace in their office positively. The first edition of the Medical Office Survey on Patient Safety Culture: 2012 User Comparative Database Report provides results from 23,679 staff from 934 U.S. medical offices. The report helps medical offices compare their patient safety culture scores with other medical offices. It contains detailed comparative data on the survey by number of providers, specialty, ownership, region, and by staff position. Select to access the survey that can be used by medical offices, health systems and researchers to assess the opinions of medical office staff about patient safety issues and overall quality of care. It measures 10 areas of patient safety culture as well as overall ratings on quality and patient safety.

Am thinking that maybe the amount of “paperwork” would be factor in the ratings.
And that more providers could potentially affect ratings.
Maybe so..an excerpt from the summary

Number of Providers

  • Medical offices with one or two providers had the highest average percent positive on all 10 patient safety culture composites.
  • Percent positive scores (those responding “Excellent” or “Very Good”) for all five Overall Ratings on Quality were higher for medical offices with fewer providers.
  • Medical offices with two providers had the highest (74 percent) percentage of respondents who gave their medical office an Average Overall Rating on Quality and Patient Safety of “Excellent” or “Very good.” Medical offices with 14 to 19 providers had the lowest (57 percent).

June 4, 2012 Posted by | health care | , , , , , | Leave a comment

Diagnostic Codes & Misleading Clinical Assumptions (Explains Why Pneumonia Cases Were Underreported Nationwide)

Bottom line…an author had used codes which underreported pneumonia cases by not taking into account diagnoses where pneumonia was a secondary diagnosis

 

From NLM Director’s Comments Transcript
Diagnostic Codes & Misleading Clinical Assumptions: 05/29/2012

Purported declines in pneumonia hospitalization and mortality rates were misleading because a standardized clinical diagnostic coding system was interpreted one-dimensionally, find an illuminatingstudy and an accompanying editorial recently published in the Journal of the American Medical Association.

Both the study and the editorial suggest subtle revisions in the use of diagnostic codes and related reimbursement procedures can impact hospital data and alter inferences about patient results as well as the quality of health care provided by U.S. hospitals, clinics, and health care providers….

n the study, five authors initially found a 27 percent decline in hospitalization and a 28 percent decline in mortality rates from pneumonia during 2003-2009 by using a patient results database that is undergirded by a nationally used diagnostic code system. The coding system is called the International Classification of Diseases, Ninth Revision, Clinical Modification, which is often referred to as ICD-9-CM. ICD-9-CM is used by hospitals, clinics, and health care providers nationwide to code patient diagnoses and is a foundation for administrative and patient records as well as insurance billing.

The study’s authors explain the Nationwide Input Sample (grounded in ICD-9-CM diagnostic codes) suggested there were significant improvements in hospitals and clinics across the U.S. in the treatment of pneumonia, which also were reported in other, smaller studies.

However, the study’s authors checked the identical dataset for hospitalization rates by using a more multidimensional definition of pneumonia within ICD-9-CM codes. The authors asked how many patients were diagnosed with sepsis and respiratory failure with a secondary diagnosis of pneumonia during the same time period? The authors found the hospitalization and respiratory rates increased by 178 percent and nine percent respectively for patients diagnosed with sepsis and respiratory failure with a secondary diagnosis of pneumonia.

When the study’s authors then combined a primary and secondary pneumonia diagnoses from the same dataset, they found an overall 12 percent decline in pneumonia-related admissions and a six percent increase in mortality occurred from 2003-2009. In other words, the addition of two other codes for pneumonia diagnoses partially refuted the initial reports of highly reduced hospitalization and mortality from pneumonia.

The study’s authors write (and we quote) ‘the results suggest that secular trends in documentation and coding, rather than improvements in actual outcomes, may explain much of the observed change in this and other studies’ (end of quote).

The study’s authors explain the current research is the first to assess hospitalization and mortality rates using a multidimensional diagnostic definition of pneumonia.

Similarly, the editorial’s authors write and we quote): ‘nuances in the assignment of principal and secondary diagnoses (in ICD-9-CM codes) can also affect assessment of hospital performance’ (end of quote).

Among other examples, the editorial’s authors add the use of sepsis as a diagnosis among patients with pneumonia may have increased significantly from 2003-2009 because the reimbursement potential for sepsis (based on diagnosis related groups) was higher than pneumonia during this period. The editorial’s authors write (and we quote): ‘Under prospective payment, there is a wide variation in reimbursement for different diagnosis related groups (DRGs), creating incentives to identify principal diagnoses associated with higher reimbursing DRGs’ (end of quote).

While the editorial’s authors acknowledge ICD-9-CM codes and DRGs (as well as other, related information) make it easier to use administrative data to assess health care delivery and quality of care, they underscore it is important to judiciously interpret the methods and findings. The editorial’s authors conclude (and we quote): ‘the potential for misleading interpretation of findings based on naïve analysis of administrative data and a lack of appreciation of the nuances in diagnostic coding will continue to be a problem’ (end of quote).

Meanwhile, MedlinePlus.gov’s health insurance health topic page provides insights into the bottom line byproduct of diagnostic codes that impactpatients and health consumers — how to pay for a provider’s or health organization’s charges.

MedlinePlus.gov’s health insurance health topic page provides two overviews of health insurance from the American Academy of Family Physicians in the ‘start here’ section. A helpful guide to 10 ways to make health benefits work for you (from the U.S. Department of Labor) also is available in the ‘start here’ section.

A website from the American College of Physicians and the American Association of Retired Persons (available in the ‘related issues’ section) helps you understand some of the pending changes in health insurance associated with the comprehensive health care law the U.S. Congress passed in 2010.

MedlinePlus.gov’s health insurance health topic page additionally contains updated research summaries, which are available within the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. From the health insurance health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find MedlinePlus.gov’s health insurance health topic page, type ‘health insurance’ in the search box on MedlinePlus.gov’s home page, then, click on ‘health insurance (National Library of Medicine).’

MedlinePlus.gov also contains related health topic pages on: Financial Assistance, Managed Care, Medicaid, Medicare, and Medicare Prescription Drug Coverage.

Before I go, this reminder……. MedlinePlus.gov is authoritative. It’s free. We do not accept advertising …and is written to help you.

 

 

June 4, 2012 Posted by | Health Statistics | , , | Leave a comment

   

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